Digital Commons Network^™

Long Covid And Cardiovascular Diseases Among U.S. Adults: Results From The U.S. Medical Expenditure Panel Survey, Geoffrey Y Zhang, John C Lin, Dang Nguyen, Sameed Ahmed M Khatana, Thomas P Giordano

Faculty, Staff and Students Publications

Objective: Long COVID is associated with persistent symptoms including cardiovascular complications; however, the epidemiology and directionality of this association remain unclear.

Methods: Utilizing a retrospective cohort study design with cross-sectional analyses, 8,332 respondents aged 18 and older from the 2022 Medical Expenditure Panel Survey (MEPS) who had a prior COVID-19 infection, were analyzed to determine the temporal association between long COVID and cardiovascular disease (CVD), modeling each as both outcome and exposure in separate analyses.

Results: Long COVID was associated with any CVD diagnosis (OR 1.37; 95% CI: 1.05-1.80), specifically angina (OR 1.81; 95% CI: 1.18-2.77) and myocardial infarction (OR …

Hypothyroidism Is Associated With Higher Healthcare Utilisation And Higher Need For Blood Transfusion After Primary Total Knee Arthroplasty (Tka) In Patients With Osteoarthritis: A National Inpatient Sample Analysis, Sumanth R Chandrupatla, Kranti C Rumalla, Jasvinder A Singh

Faculty, Staff and Students Publications

Purpose: To examine the association of hypothyroidism with primary total knee arthroplasty (TKA) outcomes in adults with primary underlying diagnosis of osteoarthritis (OA).

Methods: We identified a prospective cohort of patients in the 2016-2020 national inpatient sample (NIS) that received primary TKA with an underlying diagnosis of OA, identified using International Classification of Diseases, Tenth Revision, Common Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS) codes in the primary procedure and diagnosis positions, respectively. We performed multivariable-adjusted regression analyses for healthcare utilisation (length of hospital stay, hospital charges and discharge destination) and clinical outcomes (blood transfusion; prosthetic fracture, dislocation or infection; …

The ‘Obesity Paradox’ In Patients Undergoing Transcatheter Aortic Valve Implantation. A Specialized Narrative Review, Johao Escobar, Iqra Riaz, Muzamil Khawaja, Hafeez Ul Hassan Virk, Joshua Hahn, Fu''Ad Al-Azzam, Zhen Wang, Mahboob Alam, Markus Strauss, Chayakrit Krittanawong

Faculty, Staff and Students Publications

Obesity has long been identified as a noteworthy risk factor for cardiovascular diseases, including aortic stenosis. Nevertheless, an unexplained phenomenon known as the obesity paradox has arisen in the context of transcatheter aortic valve implantation (TAVI), inquiring conventional beliefs. The obesity paradox refers to better clinical outcomes observed in obese individuals undergoing TAVI. These include reduced all-cause mortality, lower rates of procedural complications, and improved long-term survival rates compared to their lean counterparts. Several theories have been proposed to explain the obesity paradox in TAVI. One of the most popular is the adipose tissue-mediated cardioprotective effect hypothesis. It is known …

Midterm Outcomes Of The Self-Expanding Navitor Transcatheter Heart Valve: A Systematic Review And Meta-Analysis., Sahar Samimi, Chloe Kharsa, Mangesh Kritya, Joe Aoun, Syed Zaid, Nadeen N Faza, Stephen H Little, Neal S Kleiman, Michael J Reardon, Sachin S Goel

Faculty, Staff and Students Publications

• A 19-study meta-analysis (7743 patients) found high Navitor technical/device success.
• ≥Moderate PVL was low: 1.3% at 30 days and 0.6% at 1 year.
• Pacemaker implantation was 16.7% at 30 days and 20.4% at 1 year.
• Thirty-day outcomes were favorable: all-cause mortality 1.5% and stroke 1.7%.

Strategies And Challenges For The Recruitment Of Young Healthy Participants In The Dietary Approaches To Longevity And Health (Dial Health) Pilot Trial, Hannah E Cabre, Courtney M Peterson, Gareth R Dutton, Kimberly L Drews, Stephanie T Broyles, Robert Dubin, Laura Q Rogers, Catherine Champagne, Dennis T Villareal, Daniel S Hsia, Leanne M Redman, Corby K Martin

Faculty, Staff and Students Publications

Background: Understanding the impact of nutrition on human aging requires long-term trials in young, healthy, unmedicated adults. As part of the Dietary Approaches for Longevity and Health (DiAL Health) pilot project, we evaluated strategies for recruiting this population for aging-related dietary intervention studies.

Methods: We analyzed recruitment costs to enroll 70 participants (ages 25-49, BMI 22.0-29.9 kg/m2) across two DiAL Health sites and used NHANES data (2017-March 2020) to estimate the proportion of U.S. adults meeting partial trial eligibility. Additionally, a formative study surveyed 492 U.S. adults (≥18 years) to assess interest in aging-focused dietary trials.

Results: Of 2049 applicants …

Host- And Pathogen-Related Determinants Of Pulmonary Versus Extrapulmonary Tuberculosis, Begna Tulu, Thomas Theo Brehm, Reinout Van Crevel, Tobias Dallenga, Andrew R Dinardo, Keertan Dheda, Johanna Eggeling, Wendemagegn Enbiale, Matthias I Gröschel, Jialun Hao, Vinod Kumar, Arjan Van Laarhoven, Rolanda Londt, Gareth Prosser, Philippa Randall, Norbert Reiling, Jan Rybniker, Ulrich E Schaible, Erwin Schurr, Isabelle Suarez, Sebastian J Theobald, Robert J Wilkinson, Christoph Lange

Faculty, Staff and Students Publications

Tuberculosis (TB) primarily manifests as pulmonary TB (PTB), but extrapulmonary TB (EPTB) remains a major clinical challenge. Distinct diagnostic and therapeutic difficulties arise from differences in immune responses, pathogen behaviour and host susceptibility. However, the factors driving disease localisation are still incompletely understood. We conducted a comprehensive narrative review of studies examining differences between PTB and EPTB in terms of epidemiology, mycobacterial factors, genetic and epigenetic determinants, host immune responses, transcriptomic profiles, cytokine and chemokine patterns, and immunophenotypes. EPTB is more common among females, children, older adults and immunocompromised individuals with deficient granuloma formation. This review is intended to provide …

Discovery Of Genetic Susceptibility Variants In Pediatric And Adult Ependymoma, Joshua D Strauss, Priya B Shetty, Spiridon Tsavachidis, Jinyoung Byun, Stephen C Mack, Xiao Xiangjun, Terri S Armstrong, Mark R Gilbert, (On Behalf Of Nci-Connect);, Lisa Mirabello, Smita Bhatia, Wendy M Leisenring, Lindsay M Morton, Gregory T Armstrong, Jon Foss-Skiftesvik, Christian Munch Hagen, Jonas Bybjerg-Grauholm, (On Behalf Of Gicc), Manel Ghozal, Audrey Bonaventure, Jacqueline Clavel, Melissa L Bondy, Christopher I Amos, Thanh T Hoang, Michael E Scheurer

Faculty, Staff and Students Publications

Background: Ependymoma is a malignancy of the neuroepithelium-derived ependyma that lines the spinal cord and ventricles of the brain, occurring most frequently in young children and older adults. Genetic susceptibility to ependymoma has proven difficult to assess due to disease rarity.

Methods: We performed genome-wide association studies (GWAS) of 478 ependymoma patients and 4,841 disease-free controls of European ancestry. Ependymoma patients consisted of 117 children (< 18 years old) with whole-genome sequencing (WGS), 142 children with genotyping, and 219 adults (≥18 years old) with genotyping. Genotyped samples were imputed using the 1,000 Genomes Project as the reference panel and underwent quality control filtering. The GWAS was performed separately by age group and technology (genotyped or WGS). GWAS variants were considered significant at P < 5 × 10-8.

Results: Among pediatric subjects with WGS data, we identified a significant intronic variant in EDIL3 (rs149378, P = 1.9 × 10-8) and a nearly significant intronic variant in LHX4 (rs79008224, P = 7.2 …

Layers To Leaves: A Suite Of Modular 3d Printed Hydroponics Components For Research And Education, Ethan A Shaw, Suraj K Chandramouli, Michael P Dzakovich

Faculty, Staff and Students Publications

Hydroponics is a widely utilized technique to precisely control the plant growing environment and maximize productivity. In some cases, hydroponics systems can be expensive and require specialized expertise to build and maintain. Here, we present a suite of 3D-printed devices that can be constructed into a single or double tower hydroponics system of variable height and composition. This system is easily scalable to fit the needs of a user and can be implemented in a variety of research and educational contexts. Components in this suite can be made from inexpensive plastic filament using household-grade 3D printers. The vertical design of …

Investigating Food-Related Behaviors In Smith-Magenis Syndrome: Tailoring A Questionnaire For A Rare Disease, Citrine Elatrash, Theresa A Wilson, Alexis C Wood, Sarah H Elsea, Stephanie Sisley

Faculty, Staff and Students Publications

Purpose: Accurate measurement is essential for tracking changes in clinical outcomes. Individuals with Smith-Magenis syndrome (SMS) exhibit challenging and unique food-related behaviors. We sought to determine the best tool to capture their unique food-related behaviors.

Methods: We conducted focus groups with caregivers of individuals with SMS to evaluate two commonly used questionnaires for food-related behaviors- the Food Related Problems Questionnaire (FRPQ) and the Hyperphagia Questionnaire for Clinical Trials (HQ-CT). Based on caregiver input and clinical expertise, we adapted these existing measures into a new tool: the SMS-FRPQ. We then validated this instrument for internal consistency and concurrent validity using online …

Proceedings Of The 13th Annual Deep Brain Stimulation Think Tank: The Evolving Landscape, Chance R Fleeting, Eduardo M Moraud, Kamil Uğurbil, Doris D Wang, Wolf-Julian Neumann, Andrea A Kühn, Valerie Voon, Victor Pikov, Marie-Laure Welter, Michael D Fox, John D Rolston, Mahsa Malekmohammadi, Yagna J Pathak, Lyndahl M Himes, David Greene, Abbey S Holt-Becker, Gabriel Lázaro-Muñoz, Alexander W Charney, Amanda R Merner, Martijn Figee, Katherine W Scangos, Timothy Denison, Kent Leyde, Aysegul Gunduz, Helen M Bronte-Stewart, James C Beck, Nora Vanegas-Arroyave, Marta San Luciano, Norbert Brüggemann, Kelly D Foote, Michael S Okun, Joshua K Wong

Faculty, Staff and Students Publications

The Deep Brain Stimulation (DBS) Think Tank XIII was held September 2-4th, 2025, in Gainesville, Florida, at the Norman Fixel Institute for Neurological Diseases at the University of Florida. The theme was "The Evolving Landscape of DBS: New Indications, New Goals." This theme was a continuation of the DBS Think Tank XI and XII, which were focused on emerging technology and pushing the horizon of indications. Since its founding in 2012, the DBS Think Tank has provided a global forum for leading clinicians, engineers, and researchers in both in industry and academia to present, discuss, and debate the current state …

A High-Stakes Landing: Traumatic Innominate Artery Injury After A Skydiving Accident, Claire G. Lewis Ms, Sarah Burki Md, Mahmound Alhusseini Md, Caroline K. Scruggs Md, Margaret L. Jackson Md, Steven Eisenberg Md, Anthony Estrera Md

Summer Research Program Abstracts

No abstract provided.

Use Of Sonorheometry To Treat Trauma-Induced Coagulopathy, Dawson L. Weiss, Gabrielle E. Hatton, Miranda E. Wood, Oscar I. Estrada Munoz, David H. Kim, John A. Harvin

Summer Research Program Abstracts

No abstract provided.

Educational Attainment And Symptom Improvement In Treatment-Resistant Depression: A Longitudinal Cohort Analysis Across Treatment Modalities, Marjorie Harrison, Giselli Scaini Msc, Phd, Aspen Viamontes

Summer Research Program Abstracts

No abstract provided.

Quantifying Hemodynamics In Implantable Cardiac And Renal Support Devices Using Computational Modeling, Alexander D. De Oliveira

Summer Research Program Abstracts

No abstract provided.

Reference-Point Indentation Captures Age-Related Material-Quality Changes In Human Infant Rib Cortical Bone, Kush Patel

Summer Research Program Abstracts

No abstract provided.

Neurodevelopmental Outcomes After Posthemorrhagic Hydrocephalus Of Prematurity, Mekal S. Mathew, Rene Leal, Caroline L. Hanan, David J. Sun, Hasan K. Mubarak, Amelie D. Perrier, William E. Johnson, Micolette R. Mardik, Trevor R. Alwell, Christian Amezquita Contreras, Chance E. Hatfield, Peter H. Yang

Summer Research Program Abstracts

No abstract provided.

Epigenetic Crosstalk In Neuroblastoma Development And Progression, Nathan Drolet, Amber Wolf, Joanna Yi, Eveline Barbieri

Faculty, Staff and Students Publications

Neuroblastoma (NB), a pediatric malignancy of the peripheral nervous system, accounts for 15% of pediatric cancer deaths and remains a major challenge for cancer therapy. NB originates from sympathoadrenal (SA) progenitors of the neural crest (NC) cell lineage, whose formation and differentiation are controlled by epigenetic mechanisms. Although signaling pathways and epigenetic factors implicated in NB tumorigenesis have been well-described, a holistic understanding of how development and epigenetics overlap to drive NB is lacking. By exploring vital interplays and co-dependencies between key pathways and their epigenetic control in NC development, we have gained novel insights into the mechanisms governing NB …

Prevalence Of Clinically Relevant Nightmares And Their Differences By Sex And Diagnosis In Psychiatric Inpatients, Katrina A Rufino, Michelle A Patriquin, Courtney B Worley, Michael R Nadorff

Faculty, Staff and Students Publications

Nightmares have been shown to be associated with numerous forms of psychopathology, but the vast majority of this research has taken place in the general population and very little is known about their relation with psychopathology in those requiring inpatient hospitalization. In a sample of 1170 voluntarily admitted psychiatric inpatients, this study explores the frequency of reported nightmares in psychiatric inpatients with the aim of examining the prevalence of psychiatric diagnosis in those with and without clinically relevant nightmares. Participants completed the Disturbing Dream and Nightmare Severity Index (DDNSI) and the Structured Clinical Interview for DSM Disorders (SCID-5) at admission. …

Lessons Learned From An Epic Transformation Of A Radiation Oncology Department In Guatemala: Keys To Success, Edgar Ruiz, Hiram A Gay, Milton Ixquiac, Angel Velarde, Baozhou Sun, Jose García-Ramirez, Eric Laugeman, Benjamin Li, Jeff Michalski, Vicky De Falla, Geoff Hugo, Jacaranda Van Rheenen

Faculty, Staff and Students Publications

Purpose: We describe the radical modernization of a radiation oncology department in a developing country, Guatemala, from 2015 to the beginning of 2024. The Instituto de Cancerología y Hospital Dr. Bernardo del Valle S (INCAN) is the only public radiotherapy clinic serving patient referrals from the Ministry of Public Health and Social Assistance program.

Methods and materials: We describe the state of the radiation oncology department in 2015 versus 2024 while chronicling its gradual transformation. This multifaceted collaboration involved academic centers, government agencies, International Atomic Energy Agency (IAEA), industry, and nonprofits and continues to this day. We analyze the infrastructure, …

Blood Flow Regulates Metabolism In Hematopoietic Development, Pamela L Wenzel

Faculty, Staff and Student Publications

Blood flow modifies oxygen availability and biomechanical forces within the vasculature of the embryo as the hematopoietic system develops. The aorta-gonad-mesonephros (AGM) envelops the largest artery in the body and is a critical site for the emergence of hematopoietic stem cells (HSCs). Herein, I discuss the role of hypoxia-inducible factors (HIFs) and force as determinants of metabolism and fate determination. To address the effects of blood flow on hematopoietic development, I employ mouse embryo models and biomimetic culture. Real-time cell metabolic analyses show that oxygen consumption rates (OCR) and extracellular acidification rates (ECAR) are altered by flow in cultures of …

Multisite, Multiancestry Genome-Wide Association Study Meta-Analysis Of Functional Seizure Disorder In A Hospital Sample Of 675,680 Patients, Slavina B Goleva, Costin Leu, Yen-Chen Anne Feng, David Burstein, Sanan Venkatesh, Rebecca Birnbaum, Veera M Rajagopal, Peter Straub, Jakob Christensen, Jocelyn F Bautista, Robyn M Busch, Imad M Najm, Jakob Grove, Anders D Børglum, Georgios Voloudakis, Panos Roussos, Jordan Smoller, Dennis Lal, Lea K Davis

Faculty, Staff and Student Publications

Background: Functional seizures (FS) are paroxysmal episodes that phenotypically resemble epileptic seizures but are not associated with brain epileptiform discharges; they are also known as psychogenic nonepileptic seizures. The exact etiology and pathophysiology of FS is unknown; however, trauma and stress-related disorders are known risk factors.

Methods: We used a validated algorithm applied to electronic health records to identify individuals with FS in 6 international biobanks and hospital sites. We conducted a multisite FS genome-wide association study (GWAS) meta-analysis, including 10,910 FS cases (9040 predicted European ancestry [EA] and 1870 predicted African ancestry [AA]) and 664,500 (561,150 EA and 103,350 …

Improving Nursing Compliance With Pain Reassessment Documentation After Analgesic Administration, Dorcas Okunola

Doctor of Nursing Practice Final Project Abstract

Improving Nursing Compliance with Pain Reassessment Documentation After Analgesic Administration

PURPOSE: This quality improvement project aimed to increase registered nurse (RN) compliance with documenting pain reassessment within 30–60 minutes after analgesic administration in an adult medical–surgical trauma unit at a large academic medical center.

BACKGROUND: Timely pain reassessment is essential for evaluating treatment effectiveness and ensuring safe, patient-centered care. Baseline audits showed inconsistent documentation and compliance below institutional expectations. Evidence supports the use of electronic health record (EHR) prompts combined with targeted nursing education to improve adherence.

METHODOLOGY: A 12-week quality improvement initiative was conducted to reinforce adherence to the …

Implementing An Evidence-Based Wound Care Protocol For Inpatient End-Of-Life Residents That Aligns With Hospice Comfort Care Goals, Oge C. Okeke

Doctor of Nursing Practice Final Project Abstract

Implementing an evidence-based wound care protocol for inpatient end-of-life residents that aligns with hospice comfort care goals.

Purpose

This quality improvement (QI) project aimed to adopt a patient-centered, comfort-focused approach to wound care at the DNP project site and improve patient outcomes by increasing nursing staff's knowledge of evidence-based wound treatment strategies by 20%.

Background

Curative treatments involving aggressive methods do not align with hospice principles. Residents at the project site experience increased suffering at the end of life because of limited nursing knowledge of evidence-based, atraumatic wound care practices for end-of-life patients.

Results

Pre-intervention nursing knowledge survey scores ranged …

Improving Handoff Communication Among Uaps In A Group Home By Implementing Standardized Sbar Tool And Evaluating Its Impact On Communication Quality And Resident Safety, Ola Iweala

Doctor of Nursing Practice Final Project Abstract

Purpose

Improving handoff communication among unlicensed assistive personnel (UAPs) in a group home through Situation, Background, Assessment, Recommendation (SBAR) tool implementation.

Background

Communication failures during shift handoffs among unlicensed assistive personnel (UAPs) in a group home contributed to missed information, inconsistent care, and resident safety events. Baseline observations showed that only 37.5% of handoffs met criteria for high-quality communication, and approximately 75% of safety incidents were related to communication breakdowns.

Methodology

This project was conducted in a group home serving adults with intellectual and developmental disabilities and included 19 UAPs. The Plan-Do-Study-Act (PDSA) model and Adult Learning Theory guided implementation. …

Improving First Case-On-Time Starts In The Operating Room By Implementing A Visual Patient Readiness Assessment Tool: A Pilot Quality Improvement Project, Xochitl I. Miranda-Khayat

Doctor of Nursing Practice Final Project Abstract

Purpose

Delays in first case on-time starts (FCOTS) impact operating room (OR) efficiency, causing compounding schedule delays. This quality improvement (QI) project implemented a visual readiness tool to standardize communication and increase FCOTS rates.

Background

The project was implemented in a 5-room OR in an academic teaching hospital in the Texas Medical Center.

Methodology

Plan-Do-Study-Act (PDSA) cycles and the Consolidated Framework for Implementation Research (CFIR) guided continuous improvement and contextual factors evaluation. Following multidisciplinary education, the visual tool was implemented. De-identified FCOTS data was extracted from the electronic health record (EHR). Qualitative feedback was gathered via Qualtrics (n=17 pre-implementation) and …

Improving Prostate Cancer Patients’ Experience And Understanding With A Pre-Ct Simulation Checklist In Genitourinary Radiation Oncology, Christopher Le

Doctor of Nursing Practice Final Project Abstract

Improving Prostate Cancer Patients’ Experience and Understanding With a Pre-CT Simulation Checklist in Genitourinary Radiation Oncology

Purpose

The purpose of this quality improvement (QI) project was to implement a Pre-CT Simulation checklist for Prostate cancer patients in the outpatient Radiation Oncology Genitourinary clinic to improve patients’ experience and comprehension on their Simulation Day.

Background

The CT simulation is a critical step in treatment planning. Lack of clear, concise, consistent instruction and education preparation prior to simulation day can delay planning and treatment. Currently, there is no standardized checklist to ensure patients are educated and prepared for their CT simulation day. …

Improving Clinic Workflow To Enhance Rubeola Immunity Screening In Pregnant Patients, Courtney Mcduffie

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to improve provider adherence to Rubeola IgG serum order entry for prenatal care visits by implementing a standardized workflow and an electronic medical record (EMR)-based order-entry process in a high-risk maternal outpatient clinic.

Background: Rubeola infection during pregnancy is associated with significant maternal and fetal complications. Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) to use serologic testing to determine immunity status, inconsistent provider ordering practices and workflow gaps contribute to missed opportunities for identifying non-immune patients and planning post-partum vaccination.

Methodology: A ten-week intervention period utilized …

Mid-Shift Huddle To Improve Icu Nurse Well-Being And Reduce Burnout, Jesse Cannizzo

Doctor of Nursing Practice Final Project Abstract

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Mid-Shift Huddle to Improve ICU Nurse Well-Being and Reduce Burnout

Purpose

Burnout among ICU nurses negatively affects well-being, job

satisfaction, and retention. This quality improvement project

evaluated a mid-shift support huddle to identify staff stressors

and improve nurse well-being.

Results

The mid-shift support huddle identified high-stress events during 44% of

completed huddles, with workload and unsafe assignments as the

primary concerns. ProQOL scores improved, while employee

engagement findings were mixed, with unchanged well-being and lower

perceived stress manageability.

Background

ICU nurses provide high-acuity care, manage heavy workloads, and

experience emotional fatigue. Brief team huddles and leadership

engagement may improve …

Implementing A Standardized Diabetic Retinopathy Screening And Education Protocol In An Optometry Clinic: A Quality Improvement Project, Jadaven Edmond

Doctor of Nursing Practice Final Project Abstract

Abstract

Purpose: The purpose of this quality improvement project was to improve adherence to standardized diabetic retinopathy screening among adults with diabetes at an outpatient optometry practice in the Greater Houston area.

Background: Diabetic retinopathy (DR) is a leading cause of preventable blindness among adults in the United States. The American Diabetes Association recommends annual dilated eye examinations for all patients with diabetes; however national adherence rates remain at only 50–60%.

Methodology: A 12-week quality improvement initiative was implemented using the Plan-Do-Study-Act model. Interventions included staff education, EHR prompts for the diabetic eye-care protocol, pre-visit identification of patients with diabetes, …

“Shaking The Ladder” Reveals How Analytic Choices Can Influence Associations In Nutrition Epidemiology: Beef Intake And Coronary Heart Disease As A Case Study, Colby J Vorland, Lauren E O'Connor, Beate Henschel, Cuiqiong Huo, James M Shikany, Carlos A Serrano, Robert Henschel, Stephanie L Dickinson, Keisuke Ejima, Aurelian Bidulescu, David B Allison, Andrew W Brown

Children’s Nutrition Research Center Staff Publications

Nutrition epidemiological models involve many analytic decisions, such as defining exposures, selecting which covariates to include, or configuring variables in different ways. We explored the impact of analytical decisions on conclusions in nutrition epidemiology using self-reported beef intake and incident coronary heart disease as a case study. We used REasons for Geographic and Racial Differences in Stroke (REGARDS) data, and selected covariates and their configurations from published literature to recapitulate common models used to assess associations between meat intake and health outcomes. Three model sets were designed: sets one and two used continuous and quintile-defined beef intakes, respectively, each with …